Individual
FADI PAUL JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 NORTH WOLFE STREET, BALTIMORE, MD 21287-2109
(410) 955-5000
Mailing address
733 RUTLAND AVENUE, BALTIMORE, MD 21205-2109
(410) 955-3080
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
055347519
GA
Other
Enumeration date
01/08/2016
Last updated
01/08/2016
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